论重症急性胰腺炎治疗观念的转变

Changing strategy of severe acute pancreatitis management

对重症急性胰腺炎（severe acute pancreatitis,SAP） 的治疗,争议从来没有停止过;对SAP,我们从来未曾真正地了解.1989年,美国麻省总医院病理学家Fitz对SAP进行了定性、分类,并认为手术治疗是可行的. 胰腺的外科手术包括胰周引流、胰包膜切开、

In 1989, Fitz defined and classified severe acute pancreatitis （SAP） and he thought that surgical treatment of SAP is feasible. Since then, the strategy of treating SAP was a controversial issue over past decades. Currently, relevant literatures reported that medical or minimally invasive treatments are superior to surgical treatment, while it is too early to make the final conclusion because of the complexity of SAP. From 1989 to 2008, 1852 patients with acute pancreatitis were treated at the General Hospital of PLA, and the clinical data of 18 patients who died of SAP were retrospectively analyzed. Based on the analysis, we concluded that medical conservative therapy and surgical operative therapy should not be opposed to each other. Selecting ideal timing and appropriate operation on the basis of pathological changes of retroperitoneum and pancreatitis should be considered seriously, and the new concept of ＂miniaturization of trauma＂ should also be introduced in treating SAP.